If you are an injured worker reading this article, then one of three things is probably right:
1. Your orthopedic surgeon or neurosurgeon has recommended that you undergo a spinal fusion surgery for your back or neck problems. But, you are hesitant to have the surgery and want to negotiate a workers compensation settlement.
2. You underwent a laminectomy or discectomy for your work injury. But it did not resolve your back or neck pain. Now your treating physician has recommended you undergo a spinal fusion.
3. You already had spinal fusion surgery and now want to settle your workers comp claim.
Whatever the reason, I can help.
Injuries to the neck and back are some of the most common injuries suffered on the job. But this does not make them any less severe.
Even if your initial diagnosis is a muscle strain, there is a risk you will be diagnosed with a herniated disc. There is also a risk that your on-the-job injury will result in post-traumatic arthritis, or aggravate, accelerate, worsen, or flare any degenerative disc disease or osteoarthritis you have. One study found that more than 60 percent of workers comp claims that involved spinal fusion surgery was first reported as cervical or lumbar strain or sprain.
The purpose of this article is to discuss:
Keep reading to learn more.
And if you have any questions about how workers comp works, or are looking to hire a work injury attorney who has obtained results for more than 1,000 injured employees across the state, call me for a free consultation: (804) 251-1620 or (757) 810-5614. I am ready to help.
A spinal fusion is a surgical procedure where your surgeon unites two or more spinal vertebrae so that motion no longer occurs between them and they heal into a single bone. Put simply, a spinal fusion, also called arthrodesis, is a “welding” process.
There are many different spinal fusion techniques. But they all have the same goal: To immobilize and stabilize your spine by decompressing the spine and using bone graft to help your vertebrae join together when healed, with the hope that you get pain relief and can avoid further neurologic deficit. Spinal fusion surgery can help prevent further worsening of your ability to function but is less likely to improve it.
A spinal fusion can be performed at any level of the spine – cervical, thoracic, and lumbar. Lumbar and cervical fusions, however, are more common than thoracic fusions. That is because your lumbar and cervical spine are more mobile (have a greater range of motion) than your thoracic spine and, therefore, at greater risk of suffering sudden trauma or degeneration from repetitive stress and movement.
A cervical or lumbar fusion is a surgical procedure with substantial risk. It requires the surgeon to navigate an area with countless nerves and muscles. One mistake can result in spinal cord injury such as paralysis. And even if the surgery goes well, there is no guarantee that your neck or back pain, or the radiating pain to your arms or legs, will go away forever.
These risks are why spinal fusion is often the last resort for workers who have suffered a neck or back injury. If conservative treatment (epidural steroid injections, chiropractic care, physical therapy, etc.) is helpful, many doctors will advise against fusion.
There are, however, times when a spine fusion surgery is recommended and may be your best option. Your surgeon may recommend fusion if your spinal range of motion is disrupted, either from trauma at work, a car accident, a slip and fall, a fall from a height such as a roof or ladder resulting in a fractured vertebrae (both burst fractures and vertebral compression fractures), a herniated disc that causes cauda equina compression syndrome, or worsening degenerative changes (spinal stenosis, spondylosis, lordosis, spondylolisthesis, scoliosis, etc.), or secondary to a failed back surgery, and causing significant pain and instability in the spine.
Your doctor may recommend cervical fusion if you both a positive myleogram, CT, or MRI (meaning it shows a herniated nucleus pulposus or spinal cord impingement caused by central disc displacement or something else) and one or more of the following neurologic signs:
Neck pain alone, without other neurologic signs, is usually not a sufficient basis to undergo a cervical spine fusion.
Your surgeon may recommend lumbar spinal fusion surgery if you have positive findings on objective testing and one or more of the following:
Last year surgeons performed more than one million spine surgeries, with more than 300,000 of those being spine fusions.
Lumbar fusions are the most common type of fusion performed each year, followed closely by cervical fusions. Far fewer thoracic fusions are performed, though the number is still more than 20,000 per year.
From what I have seen, the number of complex fusion procedures performed has increased over the past five years.
The spinal fusion technique and procedure your surgeon chooses depends on the level of the spine being operated on and the location of the nerve root impingement.
Fusions are done either on the anterior (our surgeon will approach your spine from the lower abdomen for a lumbar fusion or front of the neck for a cervical fusion), posterior (your surgeon will approach from the back), or both sides of the spine (lateral approach).
Over the past twenty years there has been an increase in the use of spinal instrumentation systems that use hardware such as pedicle screws, plates, rods, wires, hooks, and cages of different materials. That is because these techniques have higher union rates than non-instrumented fusions, which means your bones are more likely to fuse together when healed.
The most common fusion procedures for the cervical spine are:
The most common fusion procedures for the lumbar spine are:
The most common fusion procedures for the thoracic spine are:
Make sure you discuss the specifics of each of these spinal fusion procedures once you know what type is recommended.
Yes. As long as you receive a Workers Compensation Award Letter providing medical benefits for your work injury and you can prove that the proposed spine fusion procedure is reasonable, necessary, and related to that injury.
Do not, however, expect the insurance carrier to agree to pay for this surgery without a fight. Because spinal fusion surgery is so expensive and so risky, most insurance carriers will deny your claim for authorization and payment of the fusion and try to find some defense to your workers comp claim, even if they have paid for everything else without hesitation. For example, do not be surprised if the insurance claim adjuster suddenly disagrees with the doctor you chose from the workers comp panel and have been treating with for years, and sends you to an IME doctor to try to find a way not to have to pay for the fusion. The insurer will try to convince you that it may win at a workers comp hearing so that you accept a lower settlement amount for your spine fusion case.
Common defenses to claims for spinal fusion surgery include:
It is possible to overcome each of these defenses by preparing your case from the beginning as though the necessity and reasonableness of the spinal fusion surgery will be disputed by the insurance company.
In my experience the average workers comp settlement amount for spinal fusion cases is $150,000.00 to $225,000.00, or higher. I have settled multiple cervical and lumbar fusion cases for more than $250,000.00, including several for more than $325,000.00 and one for more than one million dollars. The general rule is that a multilevel lumbar fusion, one-level neck fusion, and one-level thoracic fusion are worth more than a single-level lumbar fusion settlement. This is because the more levels fused, the greater the possibility of complications and permanent impairment.
I examine the following factors when calculating the settlement value of a spinal fusion claim under workers comp:
These factors are a good starting point for calculating a fair settlement amount for a work-related spinal fusion. There are more.
Many of my clients, including truck drivers, nurses, warehouse workers for large companies such as Amazon, Target, and Walmart, construction workers, delivery drivers for companies such as UPS and FedEx, flight attendants for airlines such as United Airlines and American Airlines, mechanics, utility linemen, and police officers, have improved after a lumbar or cervical fusion. But some have not. And there is at least one study that found spinal fusion surgery leads to worse long-term outcomes compared to nonsurgical treatment.
Dr. Trang Nguyen of University of Cincinnati College of Medicine led a study that suggested spinal fusion surgery may not be an effective operation for workers comp patients with degenerative disc disease, herniated discs, or nerve root disease. Spine published the results of the study in its February 15, 2011 issue.
The study used Ohio workers compensation data to identify and compare the results of patients who underwent spinal fusion for low back pain with those who underwent nonsurgical treatment for their back pain. It compared final treatment outcomes including return to work, disability, and the use of opioid drugs for pain management.
The study found that 11 percent of the lumbar fusion patients had permanent disability, compared to 2 percent of patients who treated without surgery. The spinal fusion patients were more likely to continue using pain medication. And there was a risk of some type of complication post-surgery and the need for repeat surgery. Complications include deep vein thrombosis (DVT), pulmonary embolism, nerve injuries, infection, and difficulty with bone grafts or instruments used in the procedure. And repeat surgeries occurred due to the fusion not “taking.”
This study is not the only source bringing attention to the risks associated with spinal surgery. The Minnesota Department of Labor and Industry has published a fact sheet detailing the concerns associated with lumbar fusion surgery. The sheet states that up to 1/3 of workers compensation lumbar fusion patients report a “poor” result.
Yes. In most cases.
You may decide that spinal fusion surgery is too risky for you, no matter the amount of pain you have. Many of my clients reach that decision after talking with their treating physician, seeing another orthopedic surgeon for a second opinion, and discussing the surgery with me and their family. It’s not surprising. Spinal fusion is a high risk surgery that comes with serious complications, including death.
Under the Workers Compensation Act and the Rules of the Workers Compensation Commission, your employer and its insurance company can stop your workers comp benefits if you unreasonably refuse medical treatment. But this action is rarely, if ever, taken by employers and insurers when an injured worker refuses to have spinal fusion surgery. That is because (1) fusion surgery is expensive and insurers would rather not have to pay for it and (2) fusion surgery comes with substantial risk and there may be a significant chance that it won’t help your pain or mobility.
You have an even stronger argument for refusing to undergo spinal fusion that involves more than one level. The success rate for fusion surgery decreases as more levels are fused together.
You also have justification for refusing spinal fusion surgery if you underwent a discectomy for the injury before, with no improvement or recurrent pain and loss of function.
If a fusion has been recommended and you are undecided about moving forward or firmly against having the surgery, that is fine. But do not tell the insurance company of the third party administrator (TPA) managing your claim. If the insurer or TPA (Sedgwick, Gallagher Bassett, ESIS, Landon Companies, etc) know that you will not have the surgery, then they will likely offer you a lower settlement amount for your spinal fusion claim.
If you decide not to undergo a recommended fusion surgery or settle your claim, you may still receive additional medical treatment.
You may also request vocational rehabilitation services to try to help you find a new job if you are unable to return to your pre-injury job because of the fusion. But talk with an attorney first. Vocational rehabilitation often causes problems and disputes that lead to litigation.
If you or a loved one has suffered a spinal injury at work or caused by another driver’s negligence, and now needs cervical, lumbar, or thoracic fusion surgery, call me for a free consultation: (804) 251-1620 or (757) 810-5614.